• Chi Heon Kim, Chun Kee Chung, Sun-Ho Lee, Tae-Ahn Jahng, Seung-Jae Hyun, Ki-Jeong Kim, Sang Hoon Yoon, Eun-Sang Kim, Whan Eoh, Hyun-Jib Kim, Kyoung-Tae Kim, Joo-Kyung Sung, and Yunhee Choi.
• Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.
• Eur Spine J. 2016 Dec 1; 25 (12): 4025-4032.

PurposeSimpson grade II removal (coagulation of the dural attachment after gross total removal) of spinal meningioma is considered an acceptable alternative, but increased recurrence after more than 10 years has been reported. More attention must be paid to the long-term surgical outcomes after Simpson grade II removal.MethodsA retrospective review was performed for 20 patients (M:F = 5:15; age, 59 ± 9 years) with Simpson grade II removal (mean follow-up period, 12.9 years; range 10.0-17.5). Magnetic resonance (MR) imaging was conducted in 17 patients at 88 ± 52 months (range 12-157). During the same period, Simpson grade I removal (removal of the dural origin) was performed in 21 patients (follow-up, 89 ± 87 months; range 9-316). Radiological recurrence was defined as a visible tumor on a follow-up MR image, and clinical tumor recurrence was defined as the recurrence of symptoms.ResultsAt the final follow-up, neurological symptoms had improved in 16/20 patients and remained stable in 4/20. A recurrent tumor was detected in one patient due to increased back pain at 92 months postoperative, but the symptom was stable without surgery until the last follow-up (124 months). The radiological and clinical recurrence-free survival periods were 150 ± 7 months (95 % CI 136-163) and 204 ± 6 months (95 % CI 193-215), respectively. There was no recurrence after Simpson grade I removal, whereas neurological deterioration occurred in two patients after surgery.ConclusionsSimpson grade II removal may be an alternative option if the risk of complications with Simpson grade I removal is expected to be high.

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